Provider Demographics
NPI:1184814816
Name:MERRITT, NEASHA (MD)
Entity Type:Individual
Prefix:DR
First Name:NEASHA
Middle Name:
Last Name:MERRITT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 BUENAVENTURA BLVD
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34743-4513
Mailing Address - Country:US
Mailing Address - Phone:407-348-0990
Mailing Address - Fax:
Practice Address - Street 1:104 BUENAVENTURA BLVD
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34743-4513
Practice Address - Country:US
Practice Address - Phone:407-348-0990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10009438207Q00000X
FLME137416207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME137416OtherMEDICAL LICENSE